Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion
Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion
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DOI：
10.3171/2016.7.peds16310
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Russell, Kelly
中科院分区：
文献类型：
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作者：
Ellis, Michael J.;Cordingley, Dean M.;Russell, Kelly
目的本研究有2个目的。第一个目标是确定与前庭眼功能障碍（VOD）检测在初始咨询急性运动相关脑震荡（SRC）和脑震荡后综合征（PCS）的儿科患者的临床变量。第二个目标是重新检查VOD在这个临床队列的患病率，并评估VOD对恢复时间和PCS的发展的影响。方法对2013年9月至2015年5月在儿科多学科脑震荡项目中评估的所有急性SRC和PCS患者进行回顾性分析。急性SRS定义为伤后< 30天出现，PCS定义为根据国际疾病分类第10次修订标准，包括伤后30天或更长时间出现症状。初始评估包括由1名神经外科医生进行的临床病史和体格检查。对患者进行了视频点播评估，定义为存在1种以上主观前庭和动眼症状（头晕、复视、视力模糊等）和1个以上的客观体格检查结果（异常近点会聚、平滑追踪、扫视或前庭眼反射测试）。Poisson回归分析被用来确定因素，增加VOD的风险在最初的介绍和发展的PCS.RESULTS 399名儿童，包括306例急性SRC和93例PCS，被包括在内。在这些患者中，30.1%的急性SRC患者（65.0%为男性，平均年龄13.9岁）和43.0%的PCS患者（41.9%为男性，平均年龄15.4岁）在初次就诊时符合VOD标准。VOD的独立预测因素包括女性、伤前抑郁史、创伤后遗忘、头晕、视力模糊或受伤时难以集中。急性SRC患者中PCS的独立预测因素包括VOD在初始咨询，伤前抑郁史，创伤后失忆症在injure.CONCLUSIONS本研究确定了重要的潜在危险因素VOD发展后，儿科SRC的存在。这些结果提供了确证性证据，即VOD在初始咨询与长期恢复，是一个独立的预测PCS的发展。未来的研究检查临床预测规则在小儿脑震荡应包括VOD。需要更多的研究来阐明SRC后VOD的自然史，并建立有针对性的前庭康复的循证指征。
OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS.METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as present; ing < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS.RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury.CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.